Debunking Old Wives' Tales: Why Your Child Isn’t Actually on a Sugar High |
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What to Do if You Suspect Your Child Is Using DrugsSubstance use in children can start as early as… +12 More
March 17, 2022
Kids Health
Mental Health Interviewer: What should you do if you suspect your child is doing drugs? It's a scary moment for any parent. I mean, how do you know for sure? What's the best strategy for talking to them about it? How much can you do on your own and when should you see a professional? I'm going to answer those questions with our expert today, Dr. Mary Steinmann. She's a psychiatrist who specializes in child and adolescent psychiatry. Dr. Steinmann, let's start at the beginning here. We're going to cover a lot of ground today. But what is the first thing a parent should consider if they have a reason to believe that their child may be using some sort of a substance? Dr. Steinmann: So I think there's definitely a difference between experimenting with substances and actually developing a substance use disorder. And so it can actually be fairly normative or expected behavior in children and adolescents to be curious about or experiment with substances. But we also know that using substances can really place individuals at risk of developing later substance use disorders. So it's something that we want to take very seriously and be able to help parents identify signs in their own children that may warrant additional questioning or additional evaluation or perhaps even getting additional help and support and resources. Interviewer: Yeah. So if experimentation can be normal . . . I would imagine as a parent, as soon as I saw my kids or had the idea my kids were using drugs at all, I would be like, "Oh, they've got a problem." But you're saying that that's not always the case? Dr. Steinmann: That's right. It's definitely concerning behavior. It's not something that parents need to be complacent with. I think it's important to actually dissuade substance use and to talk to kids about the dangers of substance use and the potential consequences of substance use, because there are a lot of them. Kids don't tend to think about long-term risks very much. Their brains aren't hardwired to think about long-term consequences until, honestly, sometimes their 20s. And so that's where I think it's helpful for parents to kind of take a role of, "These are the rules in our house. This is what our views are. These are what our values are. Here's what's acceptable and unacceptable behavior for our house. But I am also here and open to answer questions or listen to what you have to say. Or if you find yourself in trouble, intentionally or unintentionally, I am here for you." Interviewer: So I'm a little confused. If you suspect that your child is using a substance and maybe . . . I don't know. Do parents generally have a good idea if it's early on? When you said, "Don't be complacent," do you just kind of sit back until you start seeing a problem develop, or do you jump right in as soon as there's some sort of substance use and say, "I understand this is just a natural thing. If you ever want to talk about it, we should"? I mean, I don't quite understand that differentiation. Dr. Steinmann: I think a lot of the differentiation depends on families, right? So there are some families where even alcohol use or smoking is not a practice in the home, and so there might be a different baseline for a family addressing substance use and experimentation and how they approach that topic in their children, versus maybe a family where there is recreational alcohol use, or occasional nicotine use, or what have you. And so there are some baseline cultural differences that I think go into play. We certainly want to educate our kids up front about what the dangers are, and say, even if you're comfortable as a parent, "This is kind of my own experience with using substances," talking about responsible use, if that is a value in your home. And in other homes, that might not be acceptable at all. But kind of laying down, "This is what our family values here, our baseline. I understand you may be tempted to experiment with things. Here are my concerns about that." And then also knowing your child and knowing their baseline and being able to identify if they're starting to behave differently, if they're starting to hang out with a different peer group, knowing what their peer group is and who their friends are. Having those consistent expectations is really important, but then also providing that guidance, that education, "This is what we value in our family." That may be no substance use whatsoever. That may be, "This is the concern I have about you using substances right now as an adolescent." And that's the stance I tend to take as a child and adolescent psychiatrist. It's, "I'm concerned about the effect that any substance has on your developing brain. I understand you might be tempted to use. I discourage that, but I am also here if you have questions," and not to shut down that conversation prematurely. If curiosity develops, if they're like, "Well, I see you drink all the time. Why can't I?" being prepared to kind of have those discussions so that then that increases your chances of having your child actually be honest with you if and when they start down that path, and being available to support and guide and eventually seek help, if needed. Interviewer: So it sounds like if you suspect your child is using substances, and maybe they're just at the point where they're just kind of experimenting, that's a great invitation to have a conversation at that point? Dr. Steinmann: Exactly. And even before use. I think sometimes we overestimate the age at which kids may actually be exposed to substances in schools, but we may be having these conversations too late sometimes and setting those expectations too late sometimes. And so being aware that a lot of times, by middle school, kids are already exposed to peer groups or other folks who use, and maybe thinking about this for themselves. We may be wanting to even have those conversations earlier, depending on the environments in which our kids socialize. Interviewer: And it sounds like a parent's kind of mindset is super important for this first conversation from the standpoint that I think . . . Well, first of all, what are some of the reactions that you see parents have when they find out their kids are using drugs? I can imagine there could be some anger that is probably born out of fear, because drugs can be detrimental to somebody's life. There's probably the thought that only bad kids do drugs. Are there some other reactions you see? Or what do you see? Dr. Steinmann: Fear is a big one. And I love what you just said as far as anger often being born out of fear. Anger is a very reactive emotion. We all get angry over a lot of things. But if we dig deep, a lot of times it does come from that fear, either because we're terrified of . . . We just want the best for our child. We want them to grow up to be the best version of themselves that they can be, and there are serious consequences to problematic and ongoing substance use. There can be dangers to even intermittent substance use. And so fear is a very, very common and normal response to parents. Also, that anger component of fear or fear that gets manifested as anger tends to be the emotion that then puts our kids on the defensive and shuts them down. And so even though it's a completely valid emotion and an understandable one as a knee-jerk response on the parents' end, it may be the one that we want to kind of work on our own response to continue to invite that conversation instead of making the child feel that they're a bad kid because they thought of going to a party with their friends or even tried to ask a question or to get clarification for themselves or to seek help. Very often it's that fear of anger and punishment that keeps kids from seeking help. Other common responses I get are often, "Only bad kids do that." And I think probably what parents often mean by that is the behavior is certainly concerning and undesirable, but that doesn't mean our child is a bad kid. There's a difference between the behavior and who someone is as a person, and sometimes kids can overly internalize that. And so, if a parent's response is, "Well, only bad kids do that," or, "My kid possibly can't do that," that's a form of denial that probably needs to be addressed, especially if you're starting to see telltale signs of substance use or behavior changes. And we can talk about that in a little bit. Or it can be, "Well, why are you judging my friends? They're not bad people. I know who they are. You don't," which can also raise defensiveness and unwillingness on the part of the child to engage more in that conversation. Interviewer: Let's say a parent has suspected that their child is using a substance. They've had the conversation, they followed your advice, but then they start noticing, like you mentioned, some personality changes or they start becoming more concerned that it is escalating to a different level. Is that the point that you would get your child help, or is there another intervention that a parent would do first? Dr. Steinmann: I think there are a couple different routes to go. So we have that conversation. Maybe we were lucky enough to have that conversation upfront before use even started, and the conversation had exactly the effect that we intended to have, which is to deter use. That's kind of the best possible scenario. "Hey, let's talk about the dangers of this." The kid acknowledges, "Yep, that's not a behavior that is good for me," and we move on. Maybe experimentation happened, and then I think it's important to have the conversation potentially of, "What was that like for you?" Understand what drives a behavior. We don't tend, as human beings, to engage in behaviors that don't work for us, especially in the short term in teenagers. And so some may admit, "Hey, I've been really stressed out and I tried alcohol," for example, "and it helped me to feel better." Wow. As a parent, I would want to know, "Well, what's been stressing you out? Is there something else that's healthier that we can kind of engage in? Because, once again, I have my concerns about kind of going this route to address stress and manage stress. Are there different things that we can work together on to help you out with?" and seeing if we can get to the underlying driver of that behavior. If the behavior continues despite, "Hey, we have a house rule we don't smoke, we don't engage in underage drinking, we don't engage in any forms of substance use" . . . which again is my stance, really, as a physician, because I'm concerned about that brain development . . . and the use continues, then we might need to consider additional types of interventions and understanding what's underlying that continued substance use. I'm also going to be keeping a close eye on function. Function is really, in psychiatry and in medicine and mental health, what we look for to really start to make that distinction of, "What's the difference between substance use and a substance use disorder?" And when we say the word "disorder," what we really mean is there is some impairment in academic functioning, in relationships, and that could be friends, family, etc. Are we engaging in additional risk-taking behaviors? Are we putting ourselves in safety risk by result of use? Are there legal consequences? Are we carrying vape to school, for example? All of those things would be red flags for more serious problematic use and possible disorder that might warrant additional treatment. Interviewer: When a child is using a substance, is there generally some other underlying cause? Is it really truly just kind of a symptom of something else going on? I mean, either experimentation out of curiosity or an underlying condition, or are there other reasons? Dr. Steinmann: It can be all of the above, honestly. What can start as experimentation can then kind of just spiral out into use for other reasons. Some people may never engage in use but may find themselves starting with symptoms of anxiety or depression and then are just trying to find a way out of feeling that way. And they may have tried other things or talking to friends or things like that, or hear that, "Well, taking this has helped for me. Maybe it would help you too." And so it can sometimes be a chicken-and-the-egg type of scenario, honestly. Interviewer: All right. Sounds like we have two steps so far. A parent suspects their child is using a substance, they have a conversation because it's just experimentation. Then that behavior continues, they have another conversation again asking this time, "Is there something else going on?" or, "Why are you using it?" or, "How does it make you feel?" reiterating the rules or the policies in the household. What would be the third step if it continues on past that point? Dr. Steinmann: I would say then it's probably time to get some external support and some help. And honestly, it's never too early to get external help and support. Again, if this is just a conversation that, for any reason, a parent might struggle to have with their child or not know how to approach it, it is perfectly fine to seek out professional help to help learn how to have that conversation. And there are a lot of other internet resources that are available if you don't have the ability to talk to somebody. But I would seriously then consider looking at other resources, including a therapist or a primary care physician. Not all cases of substance use disorder have to go directly to a psychiatrist, just like not all cases of depression and anxiety need to go to a psychiatrist. Sometimes talking with external supports, such as your child's pediatrician or primary care provider, someone that has an established relationship with them and knows them, can be a good middle-ground next step to get additional support before jumping into subspecialty options, although those are definitely certainly available. Interviewer: Is there a negative message given to a child when you say . . . because there's a certain weight to saying, "All right. We've got to go to the psychiatrist now." You know what I'm saying? For this problem. That comes with a whole bunch of other stigmas. Dr. Steinmann: It can. And unfortunately, getting mental health care and having mental illness needs is still really stigmatized in our society. I think that's why I generally recommend starting out with primary care if someone is having questions. Now, granted, there are times where you would want to bypass primary care. For example, if your child has been absolutely refusing to go to school or you're noticing that they're skipping school a lot or they're getting suspended or even expelled for issues related to substance use, or you're concerned that there's an imminent safety risk, such as heavy use or heavy binge use or physical consequences from that, or you suspect a really severe underlying driver for substance use, including depression or anxiety, perhaps even things like suicidal thoughts, or if you suspect another serious mental illness, those would be things that would be quite appropriate to go up to a higher, more specialized level of care. It can take a while to access the mental health system as well, and you don't want to get stuck in the lurch while your child is really struggling, especially if their imminent safety is on the line. Interviewer: When you talk about substances, drug use, what does that entail for you as a physician and a psychiatrist? Dr. Steinmann: That's a great question. I think a lot of times, when we talk about substance use, our minds automatically go to the hard stuff like heroin or cocaine or methamphetamine. We also think about alcohol and nicotine and marijuana, which are a little more readily available. But there are also, especially with teenagers . . . Think about access and what you're more likely to be able to get a hold of or afford. Or what are the underlying concerns that might be problematic in teenagers, such as anxiety or depression? This is another great example of a misperception, actually. Sometimes we think, "Well, my child is very high functioning and they do great in school. They can't possibly have issues with substance use." But I work with a lot of teenagers and young adults who may have some mild ADHD or anxiety who are very high performers and may feel compelled to be even higher performing. And so they may actually get wrapped up in overuse or misuse of cognitive enhancers, like caffeine or prescription stimulant medication. And so having an idea of kind of the breadth of things that can be misused or abused is important. It's scary and it can be overwhelming to think about, but it's important to, again, think about those underlying drivers of behavior and the type of direction that might lead even into substances we might not typically think about as being abusable. Interviewer: And some of these ways of talking to the children about substance abuse might be kind of against a particular parent's parenting philosophy. We are all raised in our own ways by our own parents, and a lot of times, that's the way we raise our children. Is this evidence-backed stuff? Should somebody just go ahead and use their instincts instead going into this conversation? What are your thoughts on that? Dr. Steinmann: I think that parents are the experts on their children, and so using your instinct can be a very powerful tool. If you are noticing that your child is not acting like themselves, I do think it's important to ask more questions and probe. And again, by asking, you're kind of almost opening the door to, "I'm interested, I'm curious about you. I care about you." Sometimes the hardest thing we can do, as parents, is to open the door to conversations that we might not be comfortable having, but by doing that, we're actually modeling for our kids that it's okay to talk about these things, that maybe their assumption that we're going to blow our stack or over-assume might be unfounded, that we want to be and try to be safe people to talk to because we have their well-being at hand. I liken it in some ways to talking about suicide, for example, and suicide prevention. There's significant data that shows that simply asking about suicide does not increase the risk of suicidal behavior. And I think the same is very true for substance use. Just because you're asking doesn't mean that you are giving permission or suggesting that they should engage in that behavior. All asking does is signaling your child that, "Hey, I'm aware that this is a problem and I want to be a person that you can rely on and trust to talk to about it." Interviewer: For a parent listening to this interview that wants to go on to get some more information, what are some good reliable sources that they could go to online to get some help framing this or figuring out the approach or whether or not they should be concerned at this point? What do you recommend? Dr. Steinmann: For reputable sources on the internet . . . because you're right, there are a lot out there and it can be really overwhelming to kind of weed through and find the best sort of reputable information. I really like the Substance Use Resource Center through the American Academy of Child and Adolescent Psychiatry. The Substance Abuse and Mental Health Administration, or SAMHSA, also has a lot of good resources. And something that I found fairly recently as a resource, that I thought was very parent-friendly type of language, is through the Child Mind Institute. And they have various questions about how to talk to your teen about substance use for parents who may not be sure on how to start that conversation.
Substance use in children can start as early as middle school. While experimentation is common in teens, it's important as a parent to know how to have conversations that can prevent abuse and protect your kids' development. Learn about the strategies that can help parents speak with their teens about the consequences of substance use and identify the best time to intervene with professional help. |
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Finer Points of Clinical FMRI Imaging |
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Overcoming the Challenges That Face the Spouse of a Stroke VictimThe effects of a stroke reach far beyond the… +8 More
July 29, 2020
Family Health and Wellness Dr. Majersik: Hi, I'm Dr. Jennifer Majersik. I'm a stroke neurologist at the University of Utah Health Care and the Director of the Stroke Center. My guest today is Dr. Alex Terrill. She's a rehabilitation psychologist in the Division of Occupational Therapy at the University of Utah Health Care. So, Alex, I've been very excited about this topic since I take care of stroke patients and when patients come in, I find we talk all about their high blood pressure and whether they're taking aspirin. But actually, it's difficult for us to talk about the partnership between the two of them and I can see, although I'm not experienced to this, I can see that there's maybe difficulties between them, but I don't always know how to deal with that with the partners. What have you seen that are some of the problems that happen between couples? Post-Stroke DepressionDr. Terrill: They follow and there are some different broader categories. I'm going to focus more on the psychology or emotion-based problems because that's my area of expertise. But one of the big changes for a certain are changes in mood. So post-stroke depression or apathy is extremely common. It occurs in about a third of stroke survivors. But it's also extremely common and some suggest that it's actually more common in caregivers, up to about 50% of caregivers who experienced depression after stroke. And so these changes in mood, they not only affect the individual but it's been shown that there's a reciprocal effect. So it's very interconnected. When one person isn't doing well emotionally, the other person isn't doing as well either. And so, for example, if you have a caregiver who is depressed, they will have a harder time doing some of the caregiving, having hard taking care of themselves on their own needs and this can actually increase the likelihood that the person who had the stroke will be hospitalized. Caregiver HealthDr. Majersik: I've also seen data saying that the caregivers health themselves is compromised and I somewhat assume that this is because they stopped going to appointments for a breast cancer screening or to get their own cholesterol checked and they're not out socializing as much. Dr. Terrill: Yes. Dr. Majersik: Sometimes, I do talk to my patients' spouses about that. "Are you taking care of yourself?" because I worry and I can tell that they probably aren't. Dr. Terrill: That's great, yeah. We see that all the time and it's something that the message that we are trying to spread is that, again, the caregiver kind of . . . everything focuses on the patient and, of course, they are too and they want to help. Sometimes they don't know what to do, but it's exhausting and they often neglect their own needs in terms of taking care of their health. Just socializing, getting some social support and we believe that that also contributes to depression is that their social circle shrinks because they're not able to get out or will not get out. Dr. Majersik: So if a spouse is looking for more help in trying to understand his or her new role, where should they go? Should they go to the usual caregiving sources of support or is there something else that they should do? Resources for CaregiversDr. Terrill: That's a good question and I think it's very individually based. I mean, certainly, getting resources for caregivers in general could help with some of the more general issues that come up. How do you find time to do some stress management or take care of yourself? And there are some resources out there. There are caregiver support groups specifically. But there's relatively little that's out there for stroke caregivers, per se, and one of the things that is unique or there are actually several things that are very unique to caregivers for stroke survivors that might not be the case in other things like old-timers or spinal cord injury, for example, along with maybe some physical changes that might happen after stroke. You do have kind of that emotional piece, the emotional component, changes in cognitions. So the way that you're thinking changes the way that you communicate. And if you think about couples talking to each other, and if one of those partners in the couple isn't able to communicate effectively, how difficult that is. And that's a fairly unique thing, I would say, to partners of stroke survivors. The other thing is that it does happen very suddenly and, often times, I would argue that practically no one is prepared for something like that when it does happen. And so you have that sudden transition to where you're taking on that role and whereas initially, you might have people rallying in helping you, social support at the hospital, once you're back out there, there's few and far between. Things drop off and it's good to know where to go. Positive Psychology in Stroke CareDr. Majersik: What are you doing now to try to help the situation? It sounds like an area that you're obviously very interested in and I'm hoping we're going to learn more in the next few years about how to help spouses and caregivers. Dr. Terrill: Yes, so one of the things that I'm working on is actually creating an intervention that is done by both partners in the couple. And rather than just focusing on kind of educational pieces for a caregiver, which is something that's more traditionally done, we actually have them both participating in activities on their own and the activities that they do together. So we like for them to have that shared experience and we have them do positive psychology-based activity. So things like expressing gratitude, working on relationships, acts of kindness, savoring. I mean there are all kinds of things that they can work on. And it really kind of helps to give that structure to ways that they can interact and share some positive moments, make that time. And that's something that we're hearing quite a bit is that after stroke happens, you kind of flail. You just survive and you want to help each other, but you don't know how and you stop interacting altogether. So and that's really a shame because your partner can be one of your biggest sources of strength and resilience and that's mutual, for both the person who have the stroke and the caregiver.
Caregivers for stroke survivors may experience depression and neglect their own health, if they do not have the support and resources available to help them understand their new role. |
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The Psychology of AddictionMany of the causes, reasons and risks of… +7 More
June 25, 2014
Family Health and Wellness Interviewer: I think most of us at one time or another may have joked that, "We're addicted to chocolate," or, "I'm addicted to that TV show," but those addictions aren't real addictions. We're going to examine addictions next on The Scope. Announcer: Medical news and research from University of Utah physicians and specialists you can use for a happier and healthier life. You're listening to The Scope. Interviewer: Dr. Elizabeth Howell is with the University of Utah Hospital. Let's talk about addiction for a second. Now everybody jokes about, "I'm addicted to chocolate." That's not really addiction, is it? Dr. Howell: Not really. I mean, some of the same brain processes are involved, but chocolate doesn't usually cause people to lose their family and their house and their life. It's a compulsion maybe to eat chocolate . . . Interviewer: Sure. Dr. Howell: . . . but it's not something that's going to kill you. Interviewer: So let's talk about true addictions. I was doing a little bit of reading, and it just really was strange to me that if somebody is truly addicted, they can't look out for their own well being, they can't make decent decisions, because a lot of times people, you'll hear them say, "Well, wow, why didn't they just make a better choice than doing drugs?" But they really don't have that ability, if I understand correctly. Is that accurate? Dr. Howell: Well, yeah. You have some choices about some things, but I think the main thing to remember is that when you're actively addicted, and you're using drugs or alcohol or both, that your brain is not working right. I mean, it's not the same as having a brain that is sort of firing on all cylinders at the same time. Interviewer: Yeah. Is it the actual addiction, or is it the drugs, or a combination of both? Dr. Howell: Both, really. Interviewer: All right. Dr. Howell: So the drugs actually, they alter how you perceive the world and how you see things, but they also do something that's very important, which is they activate the process in the brain, which is the addiction process, that really distorts how people think. So in Pennsylvania, there's kind of an epidemic of people mixing fentanyl, which is a very potent opioid, with heroin, and a lot of overdose deaths have happened because of that. And if you're someone in the public, you'll say, "Wow, that's really scary. If I were a heroin addict, I wouldn't be using anything right now . . . Interviewer: Yeah, sure. Dr. Howell: . . . because I'd be afraid I'd kill myself." Interviewer: Yeah. Dr. Howell: But if you're a real active addict, what you think is, "How did they get the good stuff?" Interviewer: Really, that's the thought process? Dr. Howell: That is the thought process. Interviewer: And they want that. Dr. Howell: And they want that, because they want something that is so good that it might kill them, and that is the insanity, as they say in the 12-step programs, of the addiction. The insanity of the disease is that your thinking is very distorted. Interviewer: And that's how they frame in the head, "I want something so good it'll kill me?" Dr. Howell: Well, it could be, yeah. Interviewer: Wow. Dr. Howell: You could get to that point. Interviewer: So inside the brain, let's say somebody just has an addiction, but they're not currently using. Dr. Howell: Right. Interviewer: Is their brain a little different than somebody without that predisposition towards an addiction? Dr. Howell: There are probably some differences in the brains of people before they ever start using. In the twin studies that have been done using alcoholic families, and alcohol is the easiest thing to study compared to other drugs, if a child was born to an alcoholic father and adopted into a non-alcoholic home, they still had a much higher risk of becoming alcoholic. The highest risk was a child of an alcoholic biological father adopted into an alcoholic home. So the nurture part, the environment, did play a certain role, but by far the biggest risk for addiction is genetic. Interviewer: Does the brain physically get rewired because of addiction? Dr. Howell: I don't know if it gets completely rewired, but there are certain genes that are turned on or off, depending on the different genes, when you start using. Interviewer: Okay. Dr. Howell: And, like you say, they're kind of laying there dormant. Interviewer: Sure. Dr. Howell: It's like a room with the lights off, but when you turn the lights on . . . Interviewer: By taking a drink or doing a drug. Dr. Howell: . . . right, then certain genes could be turned on or turned off. And the way that this happens, it's not like the first time you ever use that all the changes that happen, by the time you've been using for 20 years, are there. They happen over a period of time and in sort of wave of different changes in the brain, different parts of the brain, different systems of the brain, and it's quite complicated. I don't know if you would call it rewiring, but it's definitely a re-engineering of the brain. Interviewer: So we've talked a lot about addiction. I want to talk for a moment now, and kind of wrap this up with, if somebody is a loved one of somebody who is addicted, help them be in the mindset of the addicted person so they can better help them. Dr. Howell: I would try to imagine it as thinking of something that you feel like you have to have for life, like it's something that you need to survive. And when you're in the throes of addiction, the person who's addicted really feels as if that is the most important thing in life, that it is actually more important than food, or their children, or whatever, and that the drive to use is so strong that their behavior seems insane, because it is. Because what you can't control is the craving and the mental obsession and the compulsion. Now people obviously get into recovery, and they stop using, so we could get into this is it really a disease, can you really control it sort of debate, but what you can't control is what your brain is telling you. That's like saying if you're diabetic, I will not let my blood sugar go up. Interviewer: Yeah. Dr. Howell: You can do as much as you possibly can to keep your blood sugar from going up, but you can't always control that, because that's a physiologic process that is independent. And that's what the addiction is. Once it gets started, it's an independent physiologic process that can be managed, but it can't be just gotten rid of or controlled. Interviewer: Or cured. Dr. Howell: Or cured, yeah. Interviewer: It's always there. Dr. Howell: Right. Interviewer: So what could somebody do to help that person? Because I don't think this is a do-it-yourself sort of a thing. Dr. Howell: No, not really. And what we tell family members first is get informed and find out what you need to know about addiction and take care of yourself, because many times a person comes in for addiction treatment, their family has been trying to help them, but they've been doing it sort of in a backwards way. They're well-meaning, but they've been kind of enabling the person. They've been covering up for them. They've been bailing them out of jail. They've been doing this and that. And so you don't want to do that. Interviewer: Yeah. Dr. Howell: Yeah, because that's where I see a lot of people getting into trouble, is they have anxiety, so they're put on something else, like a benzodiazepine that's addicting, like Xanax or one of the others, and that's only going to make the problem worse. And the other thing that you need to do is make sure that besides that you're treating the psychiatric or mental problems, that you're also treating any physical problems that are going on. Somebody could have hyperthyroidism or something that could be triggering them to drink. Interviewer: Sure. Dr. Howell: I mean, there are a number of things. So the physical and the mental you want to take care of, and make sure that whatever treatment program you're looking at has the ability to check for those things and treat them, if appropriate. Announcer: We're you're daily dose of science, conversation, medicine. This is The Scope. The University of Utah Health Sciences Radio. |
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Don’t Get Stuck in the SuckMental prowess is just as important as athletic… +7 More
May 06, 2014
Sports Medicine Interviewer: Do you have a tendency to get stuck in the suck? We're going to talk about that next on The Scope. Announcer: Medical news and research from University of Utah physicians and specialists you can use for a happier and healthier life. You're listening to The Scope. Interviewer: So as a sports psychology consultant I'd imagine when you watch a game on T.V., you're probably watching it a little differently than the rest of us. I guess what I'm getting at is when you watch an athlete can you see if their having some sort of a mental issue that's preventing them from succeeding? Nicole Detling: Well, I would say first of all if I know that athlete really well, yeah, it's pretty easy for me to see if it's an athlete that I'm working with. Interviewer: Sure. Nicole Detling: Some athletes are really good at the poker face and you can't tell if they just scored the game winning score of their life or they just had something amazing happen or if they just had something really horrible happen so they approach performance pretty consistently. Others we can all see when some people melt down, right? Interviewer: Yeah. Nicole Detling: But I would say having done this for so long, I'm probably watching sports a little bit different than most people. I love watching sports. In fact, it's the only thing that's ever on my T.V. I often get people asking me if I watch shows, and I haven't even heard of half of them. Interviewer: Sure. Nicole Detling: Like if that was on during any game, the answer's "no." But typically, yeah, it's interesting because I'll watch sport and I can really appreciate the physicality of the sport so the grace, the power, the strength. It's so amazing to me what people can do with their bodies, but I can never pull that away from really assessing what's going on with them mentally, and I really like to watch games and look for physical versus mental mistakes. Having the training that I have, I can usually pick out if its just a physical mistake. Physical mistakes sometimes just happen. We just have errors sometimes. Interviewer: Like in a football game, somebody misses a catch. Nicole Detling: It depends, right? Interviewer: Yeah, how would you tell the difference? Nicole Detling: So sometimes that's just a physical mistake. Well, a lot of times, probably the layman's way to do it if you're interested in starting to do this is watch their reaction afterwards which you don't always get on T.V. because the T.V. might change to something else, right? Interviewer: Sure. Nicole Detling: But if you have an opportunity, just watch that player for just a moment. If you don't get that opportunity, watch that player on the next play and see what they do. Did they miss a block? Did they run a wrong pattern? Did they something else? How many more plays happen before that athlete gets another chance? And if you know a team pretty well and the way a coach is going to coach, it's easy to point some of those things out and find them so it's interesting because you can always see it on their face, on their body language, the shoulders slumped, the head goes down. How quickly do they pick that back up? Interviewer: Really? Interesting. Nicole Detling: For many athletes, they make one mistake and they get stuck in the mistake mentally. Why did I do that? That was so stupid. I know better. And they really beat themselves up and that typically results in another mistake and then another mistake and then another mistake, and they spiral downward. Interviewer: So the key really is to forget it. That was then. Nicole Detling: The key is to move on. Interviewer: Moving on to something else. Nicole Detling: That's exactly right, and that's something I talk about a lot is the most important play in any sport is always the next play. Interviewer: Yeah. Nicole Detling: The same is true in life. The most important play in life is always the next play. We might hate what just happened. It might have sucked. We might have looked like a complete moron out there, but you can't change it. So what I talk about is embrace the suck which basically means...right? You embrace the suck so you take a minute and you say well that sucked, but don't get stuck in the suck. And so what that means is you're focusing forward. The most important play is the next play. Not getting stuck in the suck means OK, I can't change that now but I can do something about the future. What's the next play? What am I going to do on the next play? So let's go back to the football analogy. Let's say that a receiver doesn't get another ball thrown to them for awhile, but he does have a job on the next play. He can do that job and do it well on the next play, and each next play he does when he does his job well will help him move past that mistake that he made five, ten plays ago. Interviewer: I would have a hard time believing that. I'm not trying to be argumentative, but to me it would be like now's the time I've got to catch another ball. I blocked perfectly these past three times. I blew that last block. Nicole Detling: Yep, and you are 100% right and that's where a lot of athletes go to in their minds and that's when they start making mental mistakes. So even if he missed that ball and it's just a technical error, it was not a mental mistake, chances are his next mistake will be mental, and that's the stuff I work on is teaching them to focus forward so that they don't make a mental mistake again. There's no mental mistake or mental error that's made after that. The common thought process is now I have to do it, now I've got to do it. And typically trying too hard often results in more mistakes. Interviewer: So you'd be better off just forgetting it. Nicole Detling: You'd be better off forgetting it. Interviewer: Just really trying to not even think about it. Nicole Detling: Absolutely, you'd be better of forgetting it, but easy to say, hard to do. Interviewer: When you make a mistake, a lot of times that could be an opportunity to learn and you analyze it as such, but could that be detrimental? Nicole Detling: It could be because you could still get stuck in that so athletes who have a tendency to do that, what I tell them to do is you take a moment, embrace the suck, oh that sucked, OK, acknowledge it. It did. It's OK to say that sucked. Interviewer: Do you need to say why? Nicole Detling: Nope. Interviewer: OK. Nicole Detling: What you do need to do though and this is the key part, and this is what most people... Everybody gets stuck in that suck for a minute, right? Everybody says that sucked. We all do that. We got that part down. The part we don't have down is that the next part which is the most crucial part, and that's do you fix the mistake? So you very quickly just go back, you don't even have to run the entire play through your mind, but take that moment where you made the mistake and do an image of doing it correctly. What do you need to do to do it correctly? So if it's a technical error, your fingers were curled, take a moment and see your fingers in the position they should be in to catch the ball. See yourself doing it correctly. That sets you up for success in the future. There's a lot of research that shows what imagery does for our bodies, and it actually programs our muscles for the action that we are seeing in our mind so if we replay a mistake, we are more likely to repeat that mistake the next time we play. Interviewer: Mm, the key is to change the mistake. Nicole Detling: The key is to change the mistake so see yourself doing it correctly, and if you can see yourself doing it correctly over and over and over, you're reprogramming, and the program is stronger so that the next time you have that opportunity, you're more likely to succeed. Of course, there's no guarantee, but it does increase the chances of success. Interviewer: Are there any other tricks to not getting stuck in the suck? Nicole Detling: There are all kinds of tricks for not getting stuck in the suck. Absolutely, that's a big one is focusing forward, focusing on the next play. You also have replaying and doing it correctly so you're reprogramming. For a lot of people it's the self talk, alright well that was just a mistake. That kind of stuff happens. Everybody makes mistakes. I got it on the next one. And that's going to go back to maybe some confidence training. It's one thing to say I'm going to get the next one... Interviewer: Yeah, it sounds so easy. Nicole Detling: It's another thing to believe it, right? And so if you're not one of those people who has a tendency to be able to believe that, that might be something you'd either want to work on or choose a different strategy. OK? Interviewer: OK. Nicole Detling: There could be different scenarios where getting out of your own head. A lot of athletes will go into the vacuum and that's something I notice too when I'm watching. If an athlete who tends to be vocal or will cheer on their teammates all of a sudden gets quiet after a mistake, they are over-analyzing and are stuck in their heads so get out of your head which basically means start cheering for your teammates. Interviewer: Interesting. Nicole Detling: Talk out loud. Yell things. Get out of your head, and many times just the act of getting out of your head gets you back in the present moment where the current play is happening and then you're out of that past mistake. Interviewer: Final thoughts on getting stuck in the suck? Nicole Detling: I would say embrace the suck but don't get stuck in the suck. Use the strategies. Understand that getting stuck in the suck really sucks, but there are ways to get out of that suck. Announcer: We're your daily dose of science, conversation, medicine. This is The Scope, University of Utah Health Sciences radio. |
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